Mantovani Elena, Busani Stefano, Biagioni Emanuela, Venturelli Claudia, Serio Lucia, Girardis Massimo
Intensive Care Medicine, University Hospital of Modena, Modena, Italy.
Laboratory of Microbiology, University Hospital of Modena, Modena, Italy.
Case Rep Crit Care. 2018 Aug 26;2018:7090268. doi: 10.1155/2018/7090268. eCollection 2018.
Primary infection by after dog bite is rare but may be difficult to identify and rapidly lethal. We describe a case of fatal septic shock with fulminant purpura occurred in a patient without specific risk factor two days after an irrelevant dog bite. The patient was brought to hospital because of altered mental status, fever, and abdominal pain. In a few hours patient became hypoxic and cyanotic. The patient became extremely hypotensive with shock refractory to an aggressive fluid resuscitation (40 ml/kg crystalloids). She received vasoactive drugs, antibiotic therapy, and blood purification treatment, but cardiac arrest unresponsive to resuscitation maneuvers occurred. Case description and literature review demonstrated that, also in patients without specific risk factors, signs of infection after dog bite should be never underestimated and should be treated with a prompt antibiotic therapy initiation even before occurrence of organ dysfunction.
犬咬伤后由[具体病原体未提及]引起的原发性感染很少见，但可能难以识别且迅速致命。我们描述了一例在无关的犬咬伤两天后，发生在无特定危险因素患者身上的致命性感染性休克伴暴发性紫癜的病例。患者因精神状态改变、发热和腹痛被送往医院。数小时内患者出现缺氧和发绀。患者出现极度低血压，积极的液体复苏（40 ml/kg晶体液）难以纠正休克。她接受了血管活性药物、抗生素治疗和血液净化治疗，但复苏措施无效，最终发生心脏骤停。病例描述和文献综述表明，即使在无特定危险因素的患者中，犬咬伤后的感染迹象也绝不应被低估，即使在器官功能障碍发生之前，也应立即开始抗生素治疗。
